Risk Factors for Fractures Identified in the Algorithm Developed in 5-Year Follow-Up of Postmenopausal Women From RAC-OST-POL Study

Fracture risk prediction in postmenopausal women from GO Study: the comparison between FRAX, Garvan, and POL-RISK algorithms

In the longitudinal, retrospective study, the ability of the FRAX, Garvan, and POL-RISK algorithms to predict osteoporotic fractures was compared in a group of 457 women. Using the rigid threshold of 10% showed a significant discrepancy in sensitivity and specificity of all tools. New thresholds for high risk of fractures were established for each calculator separately: 6.3% for FRAX major fracture, 20.0% for Garvan any fracture, and 18.0% for POL-RISK any fracture. Such thresholds allow for improving the diagnostic accuracy of all three calculators.

INTRODUCTION

The aim of the longitudinal, retrospective study was to compare three tools designed to assess fracture risk: FRAX, Garvan, and POL-RISK in their prediction of fracture incidence.

MATERIAL

The study group consisted of 457 postmenopausal women with a mean age of 64.21 ± 5.94 years from the Gliwice Osteoporosis (GO) Study. Comprehensive data on clinical factors related to fractures were collected for all participants. Bone densitometry was performed at the proximal femur using the Prodigy device (GE, USA). Fracture risk was established using the FRAX, Garvan, and POL-RISK algorithms. Data on the incidence of osteoporotic fractures were collected over the last 10 years.

RESULTS

During the period of observation 72, osteoporotic fractures occurred in 63 subjects. For a preliminary comparison of the predictive value of analyzed diagnostic tools, the fracture risk threshold of 10% was used. For FRAX, the fracture probability exceeding 10% was observed only in 11 subjects who experienced fractures; thus, the fracture was properly predicted only in 22.9% of women. For Garvan, the respective value was 90.5%, and for POL-RISK, it was 98.4%. That gave a very low true positive value for FRAX and a very high false positive value for Garvan and POL-RISK. Based on ROC curves, new thresholds for high risk of fractures were established for each calculator separately: 6.3% for FRAX major fracture, 20.0% for Garvan any fracture, and 18.0% for POL-RISK any fracture. Such thresholds improve the diagnostic accuracy of all compared fracture prediction tools.

CONCLUSION

The current study showed that different fracture risk assessment tools, although having similar clinical purposes, require different cut-off thresholds for making therapeutic decisions. Better identification of patients requiring therapy based on such an approach may help reduce the number of new fractures.

Height Loss Is an Independent Predictor of Fracture Incidence in Postmenopausal Women: The Results from the Gliwice Osteoporosis Study (GO Study)

BACKGROUND

The aim of a longitudinal, retrospective study was to establish variables predicting fracture incidence over a decade.

METHODS

The study sample comprises a group of 457 postmenopausal women aged over 55 years, recruited from the database of an outpatient osteoporotic clinic. Several variables with potential influence on bone status, including the measurement of body height and hip bone densitometry, were collected. BMD at the femoral neck (FN BMD) was established using a Prodigy device (Lunar, GE, USA). Current body height was compared with the maximal historical body height in early adulthood, as reported by the patient.

RESULTS

Three hundred and ninety-four women did not have fractures during the follow up, and 63 subjects presented fractures. Subjects with fracture had lower FN BMD with a T-score of -1.86 ± 1.04 compared to -1.44 ± 0.89 in those without fractures (p < 0.001). Mean height loss (HL) was 3.47 ± 2.11 cm in fractured subjects and 2.50 ± 2.47 cm in unfractured ones, and differed significantly, p < 0.01. Fracture incidence was significantly related to age, rheumatoid arthritis, falls, and previous fractures. In the multivariable analysis using logistic regression, FN BMD, baseline fracture, and HL were identified as the significant predictors of fractures of follow up.

CONCLUSIONS

Osteoporotic fractures in postmenopausal women were predicted by FN BMD, prior fracture(s), and HL easily established during physical examination.

Impaired Functional Status Increases Fracture Incidence in 10-year Follow-Up: The Results from RAC-OST-POL Study

INTRODUCTION

The aim of study was to establish the influence of baseline functional status on fracture incidence.

METHODOLOGY

In a prospective 10-years observation in epidemiological sample of postmenopausal women from RAC-OST-POL Study a thesis that affected functional status enhance fracture incidence was verified. At baseline, data were collected in 978 women at mean age 66.48±7.6 years and after 10 years of follow-up 640 subjects at mean age 75.04±6.95 years remained in the study. Functional status at baseline was established using Stand up and Go test (SAG) and Activity of Daily Living (IADL). Afterwards, annually data on fracture incidence were collected by phone interviews.

RESULTS

In the period of observation 190 low-energy fractures in 129 women were noted. The whole group was divided into subgroups: without fracture (n=511), with one fracture (n=91) and those ones who had more than one fracture (n=38). In fractured and unfractured subgroup mean SAG results were 11.36±4.28 and 10.36±2.76, respectively and differed significantly (p<0.01). With increasing number of fractures the SAG time was longer - it was 11.15±4.49 in one fracture subgroup and 11.87±3.73 in multiple fractures subgroup, with both values significantly higher than in no fracture subjects. The mean value of IADL was 23.56±1.60. In 576 (90%) women IADL reached maximal value of 24 points. In the rest of them (n=64) IADL score was between 11 and 23 points. Mean value of IADL in fractured and unfractured subgroup were 23.27±1.97 and 23.64±1.47, respectively and differed significantly (p<0.01).

CONCLUSION

The measures of functional status predict fractures in a prospective observation of representative epidemiological female sample.

Glucocorticoids Increase Fracture Risk and Fracture Prevalence Independently from Bone Mineral Density and Clinical Risk Factors: Results from the Gliwice Osteoporosis (GO) Study

The aim of the study was to establish the influence of glucocorticoids (GC) on fracture risk, probability, and prevalence. A set of 1548 postmenopausal women were divided into study group - treated with GC (n=114, age 66.48±7.6 years) and controls (n=1434, age 66.46±6.83 years). Data on clinical risk factors for osteoporosis and fractures were collected. Hip bone densitometry was performed using a device Prodigy (GE, USA). Fracture probability was established by FRAX, and fracture risk by Garvan algorithm and POL-RISK. Fracture risk and fracture probability were significantly greater for GC-treated women in comparison to controls. In the study group, there were 24, 3, 24, and 6 fractures noted at spine, hip, forearm, and arm, respectively. The respective numbers of fractures reported in controls at those skeletal sites were: 186, 23, 240, and 25. The use of GCs increased significantly prevalence of all major, spine and arm fractures. Also the number of all fractures was affected by GC use. Following factors significantly increased fracture probability: age (OR 1.04 per each year; 95% CI: 1.03-1.06), GC use (OR 1.54; 95% CI: 1.03-2.31), falls (OR 2.09; 95% CI: 1.60-2.73), and FN T-score (OR 0.62 per each unit; 95% CI: 0.54-0.71). In conclusion, in patients treated with GCs the fracture risk, probability, and prevalence were increased. This effect was evident regardless of whether GC therapy is included in the algorithm as a risk factor (FRAX, POL-RISK) or not taken into consideration (Garvan nomogram).

Height loss in postmenopausal women-do we need more for fracture risk assessment? Results from the GO Study

Human body height loss of 3-4 cm or more may be considered a simple indicator of increasing fracture risk, where the information is very similar to the results from fracture risk assessments by available online calculators, all of them based on a multiple variable approaches.

INTRODUCTION

The aim of the study was to assess the relationship between body height loss (HL) and fracture risk in postmenopausal women from the Gliwice Osteoporosis (GO) Study.

METHODS

The study sample included 1735 postmenopausal women, aged over 55 years and recruited at the Osteoporotic Outpatient Clinic. The mean age of the study participants was 68.15 ± 8.16 years. Fracture risk was established, using the fracture risk assessment tool (FRAX) (10-year probability of major and hip fractures), the Garvan calculator (any and hip fractures, 5 and 10 years) and the Polish (POL-RISK) algorithm, available at www. fracture - risk .pl (any fractures, 5 years). Bone densitometry at the femoral neck was performed, using a Prodigy device (Lunar, GE, USA). Body heights were measured before bone densitometry, using a wall stadiometer and compared with the maximum body heights, measured in early adulthood and reported by the study participants themselves.

RESULTS

In 199 women, the body heights, measured during the study, did not change in comparison to their corresponding values in early adulthood, while being decreased in the other 1536 women. The mean height loss (HL) in the whole study group was 3.95 ± 3.24 cm. That HL correlated significantly with the calculated fracture risk (the r range from 0.13 to 0.39, p < 0.0001). In general, regarding the patients with fracture risk close to the recommended therapeutic thresholds, HL was around 3-4 cm, except of the values from the FRAX calculator for major fractures, where the commonly used therapeutic threshold (20%) was related to HL of approximately 6.5 cm. In subjects with HL between 3.5 and 4 cm (n = 208), the FRAX value for major fractures was 6.83 ± 3.74.

CONCLUSIONS

Body height measurements, carried out to establish HL, provide an important information for clinical practice, where HL of 3-4 cm or more may be considered a simple indicator of increasing fracture risk.

Five-year fracture risk assessment in postmenopausal women, using both the POL-RISK calculator and the Garvan nomogram: the Silesia Osteo Active Study

The study project was designed to assess the concordance of clinical results in the assessment of 5-year fracture risk of any fracture, carried out by two methods: the Garvan algorithm and the POL-RISK model. The study group included 389 postmenopausal women of Caucasian race. The concordance of results, obtained by those two models, turned out to be moderate, and the threshold for high fracture risk group was 11% in the POL-RISK model.

PURPOSE

The goal of the study was to evaluate the concordance of results in fracture risk assessments between the Garvan Fracture Risk Calculator and POL-RISK, a new Polish algorithm, and to define an optimal threshold for intervention.

METHODS

The study was a part of the Silesia Osteo Active Study. A group of 389 postmenopausal women, aged 65.2±6.9 years (mean ± SD), was randomly selected from the general population of Zabrze, Poland. All the participants had bone densitometry examination to assess the bone mineral density of the femoral neck. The mean femoral neck T-score was (-0.99) ± 1.05 SD. 6.4% of the women revealed osteoporosis. Five-year risk of any fracture was assessed, using the Garvan and POL-RISK calculators. The performance of each model was evaluated by the area under the receiver operating characteristic curve (AUC).

RESULTS

The median 5-year risk of any fracture was 7% (range 1-54%) in the Garvan model and 8.8% (range 1.1-45.5%) in the POL-RISK algorithm. There was a significant correlation between the results obtained by both methods (r=0.6, p<0.005). For the thresholds, assumed at 8% and 13% (according to recommendation derived from Garvan tool), the rates of concordance of results between both calculators were 76% and 84%, respectively. In ROC analysis for the POL-RISK method, performed with reference to the Garvan method at two different cut-offs, assumed to be high fracture risk indicators (8% and 13%), the AUC values were 0.865 and 0.884, respectively. The optimal threshold for high fracture risk in the POL-RISK algorithm was ≥ 11%, which yielded a sensitivity of 0.94 and a specificity of 0.71.

CONCLUSION

The obtained data demonstrate a moderate concordance of results between the POL-RISK algorithm and the Garvan model, illustrated by low and high fracture risk cut-offs, established in ROC analysis. In addition, the threshold of 11% in the POL-RISK method was the optimal level for "high risk".

High rates of undiagnosed and untreated osteoporosis in postmenopausal women receiving medical services in the area of Upper Silesia

Introduction

High social cost and high risk of disability make postmenopausal osteoporosis one of major public health problem in the 21^st century. The aim of this study was to assess frequency of undiagnosed and untreated osteoporosis in postmenopausal women in the Upper Silesia Region of Poland. Additionally, we compare estimation of the 10-year probability of major osteoporotic fractures (MOF) and hip fractures (HF) based on fracture risk assessment tool (FRAX) with and without bone mineral density (BMD).

Material and methods

The survey included 450 postmenopausal women (age 65 ±11 years). A detailed questionnaire included demographic and anthropometric data, comorbidity, history of previous low-energy fractures, family medical history, and treatment for osteoporosis. The FRAX calculator was used to estimate the risk of MOF and HF.

Results

Osteoporosis was previously diagnosed in 23.7% women. Of those 70.2% were receiving vitamin D, 27% calcium preparations, 33% bisphosphonates, and 22% were untreated. Only 42.2% women with previous fractures had been diagnosed with osteoporosis and 42.8% received any treatment. 12.5% women with FRAX-BMD ≥ 10% had no risk factors of osteoporosis and < 10% risk of MOF and HF in FRAX without BMD.

Conclusions

Osteoporosis often remains undiagnosed and untreated in postmenopausal women. There is a great need to popularize FRAX without BMD calculator among physicians, especially GPs, as the risk calculation justify the implementation of antiosteoporotic therapy. Women with burden of risk factors of fractures and borderline FRAX without BMD values, should be referred to a densitometry examination, as having greater risk of fracture than shown by FRAX without BMD.